After decades of warnings about salt, the white, grainy mineral seems poised to become the grocery's next boogeyman, following trans fats, carbs and calories.
Health and consumer advocates who see a rising epidemic of high blood pressure and related disease are making the latest push, and that has food makers inching toward change.
The U.S. Centers for Disease Control and Prevention recently quantified the problem with a report saying most Americans consume more than double the daily recommended level of sodium, a major component of salt. An Institute of Medicine committee has begun exploring ways to control intake that could include new regulations, education and further efforts from the food industry.
Since sodium occurs naturally in a few foods and its use is ubiquitous, eliminating it from American diets would be impossible and not advised, because a small amount is needed for proper body function. But if reduction efforts are successful, proponents say there would be less hypertension, and less heart disease and fewer strokes, the No. 1 and No. 3 killers nationwide.
"There are a lot of dietary factors that affect blood pressure, but salt is front and center," said Lawrence J. Appel, a professor of medicine, epidemiology and international health at Johns Hopkins Medical Institutions and a salt panel member at the Institute of Medicine, a scientific advisory panel.
"Salt is why we have a blood pressure epidemic," he said. "No one knows how much salt he consumes or has easy control of it; it's why the solution is a public health one."
Appel said putting down the shaker is a start. But most salt is added during processing or in restaurant preparation. That means retooling at the plants and commercial kitchens, and changing the way we think about food.
Take pizza, one of the saltiest and most popular foods. Makers would have to dump long-used recipes for crust and sauce, which would be hard enough without the potential consumer backlash. They would also have to engineer new cheese, as salt is integral to its taste and preservation.
Appel said public tastes would acclimate to less salt quickly, if the panel is able to figure out how to make that happen. If nothing is done, he said the nation's blood pressure, which naturally climbs throughout people's lives, will continue to rise to unhealthy levels faster.
The CDC study released last month is the first to use national data to show that nearly 70 percent of adults should consume no more than 1,500 milligrams of sodium a day. They are people with high blood pressure, blacks and those older than 40 years old. Other adults should consume fewer than 2,300 milligrams a day, or about a teaspoon. But most get too much: 16 million Americans have heart disease, and 5.8 million have had a stroke.
The consumer group Center for Science in the Public Interest says restaurant and processed foods deliver more than three-fourths of the salt people consume.
The group sued in 2005 to get salt off the Food and Drug Administration list of safe food ingredients.
Center Executive Director Michael F. Jacobson said regulation is necessary because, unlike fat, the public doesn't see an obvious result of overindulging and won't demand change. There are no symptoms for disease-causing hypertension.
Jacobson is further dismayed by recent consumer trends in "gourmet" salt and "natural" sea salt, which he says is still salt.
"Salt is the new bad guy and deserves to be," he said. "It's the single most harmful thing in the food supply."
In Baltimore, where hypertension is an acute problem, the health department convened a salt task force last summer with health, industry and public representatives to identify ways to reduce consumption. Olivia D. Farrow, interim health commissioner, says recommendations will likely focus on voluntary measures and education.
A recent health survey revealed that 29 percent of Maryland adults have been told they have high blood pressure. The number jumps to 34 percent in the city and is even higher for blacks.
Officials at the Grocery Manufacturers Association say they are taking action, though the problem can't be solved overnight because Americans are used to the taste, and salt is used in production and preservation.
There are some new products, and they have buyers. For the year ending in April 2008, sales of lower-salt foods, such as soups, frozen vegetables and crackers, were $15.9 billion, behind those with claims about low-fat, natural ingredients and calories. More than 1,300 lower-salt products were introduced during that year, or 2.7 percent of all new foods and beverages.
"Today there are more and more sodium- or salt-modified products available nationwide for consumers in the marketplace," Robert Brackett, chief science officer for the association, said in a statement.
HOW TO CUT BACK
Most salt in American diets comes from food processing rather than the salt shaker. Here are suggestions on how to cut down:
* Read food labels. Salt is about 40 percent sodium, so look for the words soda, as in sodium bicarbonate or baking soda.
* Some drugs contain high amounts of sodium, so read those labels, too.
* Choose fresh, frozen or canned food without added salt. Avoid canned vegetables packed with salt.
* Substitute salt with spices with less sodium.
* Select unsalted nuts, beans and peas.
* Limit salty snacks such as pretzels and chips.
* Select unsalted soups or broths.
* When eating out, ask that your dish be prepared without salt.
* Pay attention to these foods, the most common sources of salt: meat pizza, white bread, processed cheese, hot dogs, spaghetti with sauce, ham, ketchup, cooked rice, white rolls, flour tortilla, salty snacks and whole milk.
Sources: American Heart Association and the Grocery Manufacturers Association